title: Does 11C-choline PET-CT contribute to multiparametric MRI for prostate cancer localisation?
abstract: OBJECTIVE
  The aim of this work was to determine whether 11C-choline positron emission tomography (PET)-computed tomography (CT) makes a positive contribution to multiparametric magnetic resonance imaging (MRI) for localisation of intraprostatic tumour nodules.
  
  
  METHODS
  A total of 73 patients with biopsy-proven intermediate- and high-risk prostate cancer were enrolled in a prospective imaging study consisting of T2-weighted (T2w), dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI and 11C-choline PET-CT before radical prostatectomy. Cancerous regions were delineated on the whole-mount prostatectomy sections and on the different MRI modalities and analysed in 24 segments per patient (3 sections, 8 segments each). To analyse PET-CT images, standardized uptake values (SUV) were calculated per segment.
  
  
  RESULTS
  In total, 1,752 segments were analyzed of which 708 (40.4%) were found to be malignant. A high specificity (94.7, 93.6 and 92.2%) but relatively low sensitivity (31.2, 24.9 and 44.1%) for tumour localisation was obtained with T2w, DCE and DW MRI, respectively. Sensitivity values significantly increased when combining all MRI modalities (57.2%). For PET-CT, mean SUVmax of malignant octants was significantly higher than mean SUVmax of benign octants (3.68±1.30 vs. 3.12±1.02, p<0.0001). In terms of accuracy, the benefit of adding PET-CT to (multiparametric) MRI was less than 1%.
  
  
  CONCLUSIONS
  The additional value of 11C-choline PET-CT to MRI in localising intraprostatic tumour nodules is limited, especially when multiparametric MRI is used.
authors.affiliation: Department of Radiation Oncology, University Hospitals Leuven, campus Gasthuisberg, Leuven, Belgium. laura.vandenbergh@uzleuven.be
authors.forename: L
authors.initials: L
authors.lastname: Van den Bergh
authors.forename: S
authors.initials: S
authors.lastname: Isebaert
authors.forename: M
authors.initials: M
authors.lastname: Koole
authors.forename: R
authors.initials: R
authors.lastname: Oyen
authors.forename: S
authors.initials: S
authors.lastname: Joniau
authors.forename: E
authors.initials: E
authors.lastname: Lerut
authors.forename: C M
authors.initials: CM
authors.lastname: Deroose
authors.forename: F
authors.initials: F
authors.lastname: De Keyzer
authors.forename: H
authors.initials: H
authors.lastname: Van Poppel
authors.forename: K
authors.initials: K
authors.lastname: Haustermans
mesh_terms: D000368:Aged; D002250:Carbon Radioisotopes; D002794:Choline; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000473:pathology*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D002794:Choline